[Imaging measurement for the posterior pars interarticularis screw fixation on axis].

OBJECTIVE: To explore the safety and feasibility of posterior pars interarticularis screw fixation on axis by CT measurement. METHODS: The CT data of 137 patients with complete upper cervical spine who underwent full cervical spine CT examination from January 2016 to December 2019 were collected, including 71 males and 66 females, aged from 22 to 65 years old with an average of (41.8±17.4) years old. Mimics 19.0 software was used to measure anatomical data related to the pars interarticularis screw, including the pars width, pars vertical length, pars vertical height, length of pars screw trajectory, upward inclination angle of pars screw trajectory. And the correlation between each index was analyzed. RESULTS: The axis pars has an average width of (9.05±1.63) mm, an average vertical length of (11.21±1.43) mm, and an average vertical height of (17.53±2.93) mm. The mean length of pars screw trajectory was(19.07±3.20) mm. Regarding to the length of pars screw trajectory, 94.53% of pars measured more than 14 mm, 82.12% of pars measured at 14-16 mm, 63.14% of pars measured at 16-18 mm, 39.78% of pars measured at 18-20 mm. The upward inclination angle of pars screw was 30°-68° with an average of (46.06±8.06) °. There was a highly positive correlation between the length of screw trajectory and upward inclination angle(r=0.965, P=0.000). The vertical length of pars was weakly positively correlated with length of screw trajectory and upward inclination angle(r=0.240, P=0.000;r=0.163, P=0.007). Pars width was moderately negative correlated with length of scrwe trajectory and upward inclination angle(r =-0.333, P=0.000;r=-0.380, P=0.000). CONCLUSION: The posterior pars interarticularis screw fixation is safe and reliable. It has a more wider applicability than pedicle screw fixation and can be used as an alternative to pedicle screws.

Investigation and Analysis of the Effect of Knowledge, Attitude, and Behavior of Gastrointestinal Endoscopy Nurses on Occupational Protection Against COVID-19.

The purpose of this study was to investigate the effects of knowledge, attitude, and behavior (KAB) of gastrointestinal endoscopy nurses on occupational protection against COVID-19. We analyzed the influencing factors on KAB to provide a reference for the training of nurses on occupational protection in endoscopic centers. A convenience sample of 400 endoscopy nurses from 26 provinces and cities in China was surveyed using a questionnaire to determine their KAB about occupational protection against COVID-19. Job title was an influencing factor of endoscopy nurses' attitude toward occupational protection against COVID-19. The type of hospital, whether nurses had received training on COVID-19, number of training courses received, and nurses' satisfaction with the workload in their endoscopic center were the influencing factors for occupational protective behavior. Study participants had good knowledge of occupational protection against COVID-19. Their overall attitude was positive, but their protective behavior needs further improvement. Feasible interventions to strengthen the occupational protective behavior of endoscopy nurses during the COVID-19 epidemic are suggested to improve the overall occupational protection level of endoscopy nurses.

Synchronized early gastric cancer occurred in a patient with serrated polyposis syndrome: A case report.

BACKGROUND: Serrated polyposis syndrome (SPS) is a relatively rare disease that is characterized by multiple serrated lesions/polyps. Very little is known regarding the extracolonic cancers associated with SPS. The genetic basis of the process remains unknown. CASE SUMMARY: A 67-year-old male patient initially presented with belching and abdominal distension for a year as well as diarrhea for over 2 mo. The patient underwent colonoscopy and was diagnosed with serrated polyposis syndrome. Half a year later, a gastroscopy was performed during the postoperative re-examination to screen for other lesions of the upper gastrointestinal tract. An elevated lesion was detected in the anterior wall of the gastric antrum. Curative en bloc resection of the lesion was achieved via endoscopic submucosal dissection. The pathological result was high-grade dysplasia with focal intramucosal carcinoma. Exome sequencing was performed for the patient and five gastric cancer-associated variants (methylenetetrahydrofolate reductase, metaxin 1, coiled-coil domain containing 6, glutamate ionotropic receptor delta type subunit 1, and aldehyde dehydrogenase 1) were identified. CONCLUSION: This paper reports a case that presented with both SPS and early gastric cancer. Genetic mutations that were potentially responsible for this condition were sought by exome sequencing.

Esophageal superficial adenosquamous carcinoma resected by endoscopic submucosal dissection: A rare case report.

BACKGROUND: Adenosquamous carcinoma (ASC), which is comprised of squamous cell carcinoma (SCC) and adenocarcinoma elements, is a rare histological type of esophageal carcinoma. Few reports have focused on the endoscopic findings and the effectiveness of the endoscopic treatment of early ASC. CASE SUMMARY: A 77-year-old man underwent esophagogastroduodenoscopy for heartburn. A flat lesion with an uneven and slightly elevated central portion was found in the distal esophagus. Magnifying endoscopy with narrow-band imaging showed a well-demarcated brownish area with dendritically branched abnormal vessels and highly irregular intrapapillary capillary loops. A histopathological diagnosis of SCC was obtained by endoscopic biopsy. Endoscopic ultrasonography revealed a hypoechoic mass confined to the mucosa layer. The lesion was suspected to be SCC with invasion into the muscularis mucosa. The lesion was resected en bloc by endoscopic submucosal dissection and histologically diagnosed as esophageal ASC limited within the muscularis mucosa, which was completely resected without lymphovascular or neural invasion. The SCC element was the pre-dominant element. The adenocarcinoma element formed ductal and nested structures distributed in a focal pattern. The patient underwent only endoscopic submucosal dissection and has been under annual endoscopic and radiographic surveillance for 3 years without recurrence. CONCLUSION: For early ASC confined within the mucosal layer, complete endoscopic resection might also be a curative treatment.

[Wiltse approach combined with contralateral transforaminal lumbar interbody fusion and conventional surgery for lumbar disc herniation:a case-control study].

OBJECTIVE: To compare the clinical effecty of Wiltse approach combined with contralateral transforaminal lumbar interbody fusion (TLIF) and traditional TLIF in the treatment of lumbar disc herniation and its affect on injury of multifidus muscle. METHODS: From June 2014 to September 2017, 90 patients with lumbar disc herniation combined with lumbar spine instability were divided into two groups (Wiltse approach group and traditional group) depend on the procedure of operation. Wiltse approach group was treated with Wiltse approach screw placement in one side combined with contralateral TLIF. There were 50 patients in Wiltse approach group, including 36 males and 14 females, aged 45 to 72 yearswith an average of (60.4± 3.1) years. The traditional group was treated with traditional TLIF operation. There were 40 patients in the traditional group, including 25 males and 15 females, aged 45 to 74 years with an average of (62.1±3.4) years. The operative time, intraoperative blood loss, accuracy of screw implantation, postoperative drainage volume and drainage tube removal time were recorded in two groups. Visual analogue scale (VAS) and Oswestry Disability Index (ODI)were observed before and 12 months after operation. All patients underwent CT examination preoperative and 12 months postoperative, and the CT values of bilateral multifidus muscle were measured. RESULTS: All the patients were followed up, 40 patients in traditional group were 12 to 18 months with an average of (15.3±4.3) months; and 50 patients in Wiltse approach group were 13 to 24 months with an average of (16.5± 4.1) months. There were no statistically significant differences in operative time and intraoperative blood loss between two groups (P>0.05). The accuracy of screw implantation in Wiltse approach group was higher than traditional group (P<0.05).There was no significant difference in preoperative VAS score and ODI between two groups, and 12 months after operation, VAS score and ODI in Wiltse approach group was significantly lower than traditional group (P <0.05). The postoperative drainage and drainage tube placement time in Wiltse approach group were lower than the traditional group(P<0.05). There was no statistically significant difference in CT value of multifidus muscle before operation between two groups (P>0.05), while there was statistically significant difference after operation (P<0.05). Postoperative CT values of multifidus muscles on decompression and non-decompression side were obviously reduced in traditional group (P<0.05). The CT value of the multifidus muscle on the decompression side of the Wiltse approach group was significantly lower than that before operation(P<0.05), and there was no significant difference before and after the operation on the non-decompression side (P>0.05). CONCLUSION: Compared with traditional surgical procedures, the Wiltse approach nail placement combined with contralateral TLIF has the advantage of accurate nail placement, reducing multifidus muscle damage, and reducing the incidence of postoperative intractable low back pain.

[Nomograma prediction of the surgical treatment in triad of elbow].

OBJECTIVE: To establish an individualized Nomogram prediction model for predicting the postoperative recovery of patients with triad of elbow (TE) by analyzing risk factors of triad of elbow joint. METHODS: From January 2012 to December 2018, 116 patients with TE who met the criteria were collected. The independent risk factors were screened by univariate Logistic regression analysis. The statistically significant risk factors were included in the multivariate Logistic regression model. The R software was used to establish the Nomogram diagram model to predict the postoperative recovery of TE patients. C index was used to verify the discrimination, Calibration plot of the model, and the decision curve (decision curve analysis, DCA) to verify the net clinical benefit rate of the model. RESULTS: Forty-four of the 116 patients with TE developed symptoms after operation, with an incidence of 37.93%. Age (OR=1.930, 95% CI 1.418 to 2.764), work (OR=6.153, 95%CI 1.466 to 31.362), smoking(OR=4.463, 95%CI 1.041 to 2.291), the Mason of radial head(OR=1.348, 95%CI 2.309 to 9.348), the Regan-Morrey of coronal process (OR=4.424, 95%CI 1.751 to 2.426) and postoperative elbow immobilization time(OR=7.665, 95%CI 1.056 to 5.100) were independent risk factors for postoperative recovery of TE (P<0.05). The C-index of Nomogram plot was 0.716. Calibration plot showed that the predictive model was consistent, and the DCA curve showed satisfactory clinical net benefit. CONCLUSION: The Nomogram for predicting postoperative results of TE patients based on six independent risk factors:age, work, smoking, Mason classification of radial head, Regan-Morrey classification of coronal process and immobilization time of elbow joint after operation, has good distinguishing capacity and consistency. Thepredictive model could help clinicians to identify high risk population and establish appropriate intervention strategies.

[Comparison of the accuracy of three methods for determining maxillomandibular horizontal relationship of the complete denture].

OBJECTIVE: To observe the changes of forward displacement of maxillary complete denture during centric occlusion, three different methods were used to record the changes of vertical overlap and the comfort level of patients before and after the selective grinding of the three dentures made according to maxillo-mandibular horizontal relationship record. METHODS: Twelve edentulous patients with normal stomatognathic system were recruited in this study. Three types of complete dentures for these 12 edentulous patients were made according to their different maxilla-mandibular horizontal relationship record methods. The amount of displacement of the maxillary complete denture, the vertical overlap of the anterior teeth as well as patient comfort level were recorded before and after selective grinding. Statistical analysis was performed using the SPSS 17.0 software package. RESULTS: Before selective grinding, the amount of displacement of denture A was significantly larger than those of dentures B and C (P<0.05). After selective grinding, there was no statistical difference among the three dentures (P>0.05). During selective grinding, the vertical overlap variation of denture A was significantly greater than those of dentures B and C (P<0.05). Before selective grinding, the comfort level of the denture A was the lowest (P<0.05), and no statistical difference was found between dentures B and C (P>0.05). After selective grinding, no statistical difference was found among the three dentures (P>0.05). CONCLUSIONS: Among the complete dentures with anatomical teeth, the dentures whose horizontal relationship was recorded at 1 mm before the apex of the Gothic arch apex and with checkbite are more in line with clinical repair requirements. Complete dentures whose horizontal relationship was recorded at the apex of Gothic arch need to be adjusted with selective grinding to meet the clinical restoration requirements.

[Application of single-retainer all-ceramic resin-bonded fixed partial denture in the maintenance of missing incisor gap after orthodontic treatment in adolescents: a case report].

This article reports a case of an orthodontic adolescent patient without a right inferior incisor. The right lower canine was used as the abutment. The single-retainer all-ceramic resin-bonded fixed partial denture was used to restore the complete dentition. Thus, the missing space was filled, and the function and aesthetics were restored.

[Case control study of unilateral and bilateral intervertebral space release in the treatment of lower lumbar spondylolisthesis].

OBJECTIVE: To analyze the clinical efficacy of unilateral and bilateral intervertebral space release in the treatment of lower lumbar spondylolisthesis. METHODS: The clinical data of 41 patients with lumbar spondylolisthesis treated by surgery from October 2012 and May 2016 were retrospcetive analyzed. The patients were divided into two groups, 18 cases were enrolled in unilateral intervertebral release group, there were 7 males and 11 females, aged from 47 to 75 years old with an average of (59.3±6.4) years; according to Meyerding classification, 9 cases of I degree, 7 cases of II degree, 2 cases of III degree. And 23 cases were bilateral release group, there were 11 males and 12 females, aged from 51 to 76 years old with an average of (58.2±5.7) years; according to Meyerding classification, 11 cases of I degree, 10 cases of II degree, 2 cases of III degree. The operation time, intraoperative blood loss, bone graft fusion rate of the patients were recorded in the patients. Pre- and post-operative back and leg pain were evaluated by visual analogue scale (VAS) between two groups. The slip rate, slip angle, posterior height of intervertebral space, height of intervertebral foramen, distance of anterior and posterior displacement of vertex of intervertebral foramen were measured on X-ray and CT. And the above radiographic data were analyzed by intra-group or inter-group. RESULTS: All the patients were followed up from 9 to 24 months with an average of 12 months. The entire 41 patient obtained bone fusion at 12 months after operation. There was no statistical significance in VAS at 12 months after operation, intraoperative blood loss and operation time between two groups(P>0.05). There were statistical significance in sliding angle, posterior height of intervertebral space, height of intervertebral foramen, distance of anterior and posterior displacement of vertex of intervertebral foramen of all patients before and after operation(P<0.05). There was no statistical significance in spondylolisthesis rate in unilateral release group between pre- and post-operative(P>0.05), but there was significant difference in bilateral release group. There was statistical significance in postoperative slip angle, posterior height of intervertebral space, distance of anterior and posterior displacement of vertex of intervertebral foramen between two groups(P=0.001, 0.045, 0.001). The height of intervertebral foramen increased and the slippage rate decreased in both groups after operation, but there was no significant difference between two groups(P=0.248). CONCLUSIONS: Unilateral and bilateral intervertebral space release for the treatment of lumbar spondylolisthesis can obviously reduce the rate of spondylolisthesis, restore foraminal height and achieve better clinical efficacy. Bilateral release group can better restore the slip angle, increase posterior height of intervertebral space, reduce the distance of anterior and posterior displacement of vertex of intervertebral foramen. Especially for grade II or above degree of slippage is more appropriate.

Degradation and characteristic changes of organic matter in sewage sludge using Vermi-biofilter system.

Vermi-biofilter (VF) System could be an efficient sludge treatment unit in regard of rates and extents of total chemical oxygen demand (TCOD) removal, particularly the first 10 days earthworm-treated. This study characterized the organic matter in sludge before and after VF system treatment, with or without earthworm stage. The 60 days earthworm-treated VF system reached a TCOD removal of 10,450 mg/L, bulk DOC removal of 89.5 mg/L, and earthworm density increase from 32 g/L to 43 g/L in sludge EBOM in 60 days of VF system operation. The aromatic proteins, soluble microbial byproduct-like fluorescent compounds and carboxylic components, aliphatic components (C-H related), hydrocarbon and carbohydrate materials were identified to be principally increased by 10 days earthworm-treated and then degradation in the nest days under VF system.

[Clinical outcome analysis on using extensor digitorum communis splitting approach for the treatment of radial head fractures].

OBJECTIVE: To explore the clinical outcomes of internal fixation or replacement for the treatment of radial head fractures through the extensor digitorum communis splitting approach. METHODS: From July 2012 to May 2015, 25 patients with radial head fractures were reviewed. There were 17 males and 8 females, ranging in age from 20 to 67 years old, with a mean age of 39 years old. Twenty-one patients were treated with reconstruction of plate internal fixation, and 4 patients were treated with radial head replacement. According to Mason classification, 19 cases were type II and 6 cases were type III. All the patients underwent internal fixation or replacement through the extensor digitorum communis splitting approach. The patients were followed up clinically and radiographically until the beginning of fracture union and the entrance of function recovery of elbow motion into a plateau. The functional status of the elbow was evaluated using the Mayo Elbow Performance Index(MEPI). Radiographic signs of post-traumatic arthritis were rated according to the Broberg and Morrey system. RESULTS: All the patients were followed up, and the average duration was 29 months (ranged, 12 to 56 months). The average range of flexion and extension was 120°, the extension was limited by 10°, and the flexion was 135°. The average forearm rotation range was 142°, pronation was 75°, supination was 67°. The mean MEPI was 93±7(ranged, 80 to 100 scores); according to the MEPI scoring criceria, 19 patients got an excellent functional result, 6 good. According to the Broberg and Morrey systems of traumatic arthritis, 19 patients were in grade 0, 6 in grade 1, and no patients in grade 2 or 3. No patients with nonunion of the radial head and failure of internal fixation were found. There were no complications of nerve or vascular injuries, and obvious limitation of elbow rotation. Heterotopic ossification around the elbow occurred in 4 cases, but the motion was not significantly limited. There were no complications such as prosthesis loosening and infection in 4 cases after radial head prosthesis replacement. CONCLUSIONS: The extensor digitorum communis splitting approach is an effective exposure method for internal fixation or replacement in the treatment of radial head fractures.

Results of a modified posterolateral approach for the isolated posterolateral tibial plateau fracture.

BACKGROUND: There are few posterolateral approaches that do not require the common peroneal nerve (CPN) dissection. With the nerve exposure, it would pose a great challenge and sometimes iatrogenic damage over the surgical course. The purpose was to present a case series of patients with posterolateral tibial plateau fractures treated by direct exposure and plate fixation through a modified posterolateral approach without exposing the common peroneal nerve (CPN). MATERIALS AND METHODS: 9 consecutive cases of isolated posterior fractures of the posterolateral tibial plateau were operated by open reduction and plate fixation through the modified posterolateral approach without exposing the CPN between June 2009 and January 2012. Articular reduction quality was assessment according to the immediate postoperative radiographs. At 24 month followup, all patients had radiographs and were asked to complete a validated outcome measure and the modified Hospital for Special Surgery (HSS) Knee Scale. RESULTS: All patients were followedup, with a mean period of 29 months (range 25-40 months). Bony union was achieved in all patients. In six cases, the reduction was graded as best and in three cases the reduction was graded as middle according to the immediate postoperative radiographs by the rank order system. The average range of motion arc was 127° (range 110°-134°) and the mean postoperative HSS was 93 (range 85-97) at 24 months followup. None of the patients sustained neurovascular complication. CONCLUSIONS: The modified posterolateral approach through a long skin incision without exposing the CPN could help to expand the surgical options for an optimal treatment of this kind of fracture, and plating of posterolateral tibial plateau fractures would result in restoration and maintenance of alignment. This approach demands precise knowledge of the anatomic structures of this region.

Biomechanical comparison of pedicle screws versus spinous process screws in C2 vertebra: A cadaveric study.

BACKGROUND: Biomechanical studies have shown C2 pedicle screw to be the most robust in insertional torque and pullout strength. However, C2 pedicle screw placement is still technically challenging. Smaller C2 pedicles or medial localization of the vertebral artery may preclude safe C2 pedicle screw placement in some patients. The purpose of this study was to compare the pullout strength of spinous process screws with pedicle screws in the C2. MATERIALS AND METHODS: Eight fresh human cadaveric cervical spine specimens (C2) were harvested and subsequently frozen to -20°C. After being thawed to room temperature, each specimen was debrided of remaining soft tissue and labeled. A customs jig as used to clamp each specimen for screw insertion firmly. Screws were inserted into the vertebral body pairs on each side using one of two methods. The pedicle screws were inserted in usual manner as in previous biomechanical studies. The starting point for spinous process screw insertion was located at the junction of the lamina and the spinous process and the direction of the screw was about 0° caudally in the sagittal plane and about 0° medially in the axial plane. Each vertebrae was held in a customs jig, which was attached to material testing machine (Material Testing System Inc., Changchun, China). A coupling device that fit around the head of the screw was used to pull out each screw at a loading rate of 2 mm/min. The uniaxial load to failure was recorded in Newton'st dependent test (for paired samples) was used to test for significance. RESULTS: The mean load to failure was 387 N for the special protection scheme and 465 N for the protection scheme without significant difference (t = -0.862, P = 0.403). In all but three instances (38%), the spinous process pullout values exceeded the values for the pedicle screws. The working distances for the spinous process screws was little shorter than pedicle screws in each C2 specimen. CONCLUSION: Spinous process screws provide comparable pullout strength to pedicle screws of the C2. Spinous process screws may provide an alternative to pedicle screws fixation, especially with unusual anatomy or stripped screws.

[Progress on atlanto-axial pedicle screw fixation through posterior approach].

The present of atlanto-axial pedicle screw fixation through posterior approach provide a new remedy for treating instability of pillow and cervical. A lot of researches have reported feasibility of atlanto-axial pedicle screw fixation, the results showed that it had advantages of easily exposure, less blood loss, shorter operative time, especially in treating as remedy fixation for atlanto-axial joint screw, atlas lateral mass screws and pedicle screw caused by injuries of tumor,inflammation and trauma. If not done properly, it can cause serious complications, such as iatrogenic fracture,injuries of vertebral artery and cervical spinal cord. Therefore,the safty and effectiveness of atlanto-axial pedicle screw fixation may be focus of research.

[Transoral plate internal fixation for treatment of instability atlas fracture].

OBJECTIVE: To evaluate the efficacy and safety of transoral plate internal fixation for instability atlas fracture. METHODS: A retrospective study was performed in eight patients with instability atlas fractures, who were treated by a transoral plate internal fixation from July 2007 to June 2011. There were 6 males and 2 females,with an average age of 39.5 years old ranging from 23 to 48 years. Among them, 5 case were falling injury, 3 cases were traffic accident injury. Three patients had bilateral fractures of the anterior arch (prehalf Jefferson fractures, Landells type I), 5 had anterior are fracture associated posterior are fracture (Half-ring Jefferson fractures, Landells type II), and 2 had anterior and posterior are fracture associated with single lateral mass fractures (Landells type III). RESULTS: All patients were followed up for 6 to 24 months after operation (av- eraged 13 months), and all the patients had the clinical symptoms improved to some extent. Operation time ranged from 80 to 140 min (averaged 98 min); the intra-operative blood loss was 120 to 300 ml (averaged 180 ml); and the average fluoroscopic time was 55 s. No patients happened neurological and vertebral artery injuries-related complications or other complications after operation. The followed-up X-ray and CT manifested osseous fusion in all the 8 patients,no loosening or breakage of the screws. CONCLUSION: Transoral plate internal fixation for instability atlas fracture is a reliable and safety technique that allows maintenance of rotatory mobility in the C1,2 joint and restoration of congruency in the atlanto-occipital and atlanto-axial joints.

[Clinical application of lower cervical spinous process laminar screw technique in open door laminoplasty].

OBJECTIVE: To investigate the clinical outcomes of lower cervical spinous process laminar screw technique in open door laminoplasty. METHODS: From February 2005 to June 2010,12 patients with cervical myelopathy were treated with open door laminoplasty by lower cervical spinous process laminar screw technique. There was intervertebral disc herniation with degenerative stenosis in 5 patients, ossification of posterior longitudinal ligament with osteophyte in 6 patients, cervical traumatic instability with spinal cord injuries in 1 patient. Nerve function, complications, and the cervical canal to body ratio (CBR), range of motion (ROM) and the anteroposterior serial alignment were observed by Japanese Orthopedic Association (JOA) score, X-ray, CT and MRI. RESULTS: The surgical time was from 1.5 to 2 h with an average of 110 min; blood loss during operation was from 450 to 800 ml with an average of 580 ml. Postoperative complication occurred in 1 case with upper limb pain and 1 case with cerebrospinal fluid leakage. All patients were followed up from 1 to 2 years with an average of 21.8 months. JOA score improved from preoperative 9.5 +/- 1.8 to postoperative 13.6 +/- 2.4 (P < 0.01). X-ray, CT, MRI showed CBR increased obviously (P < 0.01); ROM on flexion-extension and cervical lordosis decreased respectively from (40.0 +/- 10.0) degrees and (65.0 +/- 12.0)% before operation to (15.0 +/- 5.0) degrees and (42.0 +/- 8.0) % at the final follow-up (P < 0.01). CONCLUSION: Lower cervical spinous process laminar screw technique in open door laminoplasty for cervical syndrome is safe and can obtain satisfactory effects, has strong internal fixation and reduce the risk of re-closure.

[Anatomic study of lower cervical spinous process for laminar screw fixation].

OBJECTIVE: To measure anatomic data of spinous process and vertebral plate and evaluate the possibility of fixation of spinous process and vertebral plate. METHODS: Twenty cadaveric cervibal spines of C3-C7 were dissected to expose vertebral plate and spinous process, and were measured by two methods, one was manual measured using digital caliper and the other was computed tomography scaning. Parameters were measured manually including vertebral plate height and width. The screw was inserted from the boundary of the vertebral plate and spinous process, and gone out from the top of vertebral plate back of opposite side. Then through the CT reconstruction, angle of screw insertion, length of screw trajectory and distance between the screw tip and vertebral artery and spinal cord were measured. Additionally, spinous process width and vertebral plate thickness of 100 patients' CT scans of C3-C7 cervical segment were measured to evaluate possibility of screw insertion at spinous process and vertebral plate. RESULTS: The screw fixation of lower cervical spinous process and vertebral plate were successfully placed,without impingement of spinal cord and vertebral artery. There was no statistic difference on the data of lamina height and width of 20 cadaver specimens between manual and CT measurements (P>0.05). Height and width of vertebral plate was (12.4 +/- 1.2) to (13.7 +/- 1.3) mm and (4.5 +/- 0.9) to (5.4 +/- 1.1) mm respectively and increased gradually from C3 to C7 (P<0.05). The trajectory length was (13.7 +/- 1.2) to (15.8 +/- 1.8) mm and increased gradually from C3 to C7 (P<0.05). The distance between screw tip and vertebral artery and spinal cord was (20.1 +/- 2.7) to (25.8 +/- 2.9) mm and (4.1 +/- 1.8) to (5.0 +/- 1.2) mm respectively. The angles of screws insertion were (73.0 +/- 9.9) degrees to (85.3 +/- 10.1) degrees in the axial plane (P>0.05). Based on the CT measurements of 100 patients,the data of the spinous process width and lamina thickness varied from a minimum of (8.5 +/- 1.1) mm and (4.3 +/- 0.5) mm for the C4, to a maximum of (14.5 +/- 2.0) mm and (6.0 +/- 1.1) mm for the C7 respectively. CONCLUSION: Lower cervical spinous process and vertebral plate screw fixation is feasible, which is a safe and stable screw approach for spinous process and vertebral plate fixation.

[Posterior osteotomy and long-segment internal fixation for the treatment of senile thoracolumbar kyphotic deformity].

OBJECTIVE: To explore the therapeutic effects of posterior osteotomy and long-segment internal fixation in the treatment of senile thoracolumbar kyphotic deformity and provide the reference for operative treatment. METHODS: From April 2007 to April 2010, 19 older patients with thoracolumbar kyphotic deformity were respectively analyzed. There were 12 males and 7 females with an average age of 62 years (ranged, 58 to 74 years). Among patients, 11 cases were old fracture, 3 cases were ankylosing spondylitis, and 5 cases were old spinal tuberculosis. According to preoperative Frankel classification, 12 cases were grade E, 4 cases were grade D, 2 cases were C and 1 case was grade B. All patients were treated by posterior osteotomy and long-segment internal fixation and followed up above 1 year. VAS score preoperative, 2 weeks and 1 year after operation, Cobb's angle,n erve function and complication were observed. RESULTS: VAS score preoperative, 2 weeks and 1 year after operation separately was (7.0 +/- 1.2),(1.1 +/= .7) and (1.3 +/- .8); while Cobb's angle separately was (44.1 +/- .9), (10.9 +/- .1) and (11.5 +/- .8); there was significant difference in VAS score and Cobb's angle between preoperative and 2 weeks after operation (P < 0.05) w hile no significant difference between 2 weeks and 1 year after operation (P > 0.05). Eighteen cases met the standard of osseous fusion, 1 case occurred nonunion, but not looseness 1 year after operation. Nerve function: 3 cases changed grade E from 4 cases with grade D, 2 cases with grade C changed to grade D, 1 case with grade B changed to grade CONCLUSION: Posterior osteotomy and long-segment internal fixation for the treatment of senile thoracolumbar kyphotic deformity can receive a good short-time effects.

[Anatomic comparison between spinous process screws and pedicle screws techniques of the second cervical vertebar].

OBJECTIVE: To compare anatomic difference between spinous process screws and pedicle screws techniques of the second cervical vertebra. METHODS: Ten human cadaveric of cervical spine (5 male, 5 female) were harvested and had no gross deformities such as scoliosis and/or kyphosis were found in the study. The average age of the subjects was 60.5 years. The specimens were placed in the prone position. Posterior cervical exposure was attained by dissecting all soft tissue off the posterior aspect of the second cervical vertebra. After clear exposure of the lateral mass,the spinous process screw and pedicle screw insertion techniques were performed in this study. Each technique involved ten specimens and 10 screws inserted into C2 bilaterally. The one side of C2 was randomly selected for the spinous process screw and the other side was designate for the pedicle screw. This point then was drilled with a 3 mm drill, and followed by placement of a 4.0 mm cortical screw. The starting point for spinous process screw insertion was located at the junction of the lamina and the spinous process and the direction of the screw was about 0 degrees caudally in the sagittal plane and about O0 medially in the axial plane. The starting point of pedicle screw should be the midpoint of the base of inferior articular facet of the axis. The drilling angle was 15 degrees to 20 degrees in the superior direction and 30 degrees in the medial direction. After screw placement, all the specimens were CT scaned. On the CT scan,the length of the spinous process screw and pedicle screw trajectory were measured. Results were recorded for each screw that violated impinged of the pedicle, spinal canal and transverse process foramen. RESULTS: All the C2 spinous process screws were successfully placed, without impingement the spinal cord, the vertebral artery and the breakage of the spinous process. There was one pedicle screw breaking the pedicle into the vertebral artery foramen. The trajectory length for the spinous process screws were (21.4 +/- 1.4) mm,compared with the pedicle screws (23.7 +/- 1.0) mm. But there was no significant differences between spinous process screws and pedicle screws techniques (t = -4.387, P > 0.05). CONCLUSION: The C2 spinous process screw fixation has the anatomic feasibility and is easier to perform than pedicle screw fixation.